Provider Demographics
NPI:1568784726
Name:JDL & MAKL LLC
Entity Type:Organization
Organization Name:JDL & MAKL LLC
Other - Org Name:CHIPITA COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LONGWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-329-4810
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:1133 E. OURAY AVE
Mailing Address - City:PONCHA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81242-0627
Mailing Address - Country:US
Mailing Address - Phone:719-329-4810
Mailing Address - Fax:866-805-1874
Practice Address - Street 1:1548 G ST UNIT 2A
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2651
Practice Address - Country:US
Practice Address - Phone:719-329-4810
Practice Address - Fax:866-805-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty